Oral mucositis: preventing the side effect before undergoing cancer treatment

Source: www.curetoday.com/ Author: Katie Kosko Oral mucositis can be painful and, in some cases, require hospitalization of patients being treated for cancer with chemotherapy and other radiation therapies. However, along with your care team, you can take steps to prevent this uncomfortable side effect. In an interview CURE®, Dr. Alessandro Villa, assistant professor in oral medicine and dentistry at the Harvard School of Dental Medicine, Brigham and Women's Hospital in Boston, spotlighted the number of patients with cancer who are affected by oral mucositis, explained the benefits of two agents approved by the Federal Drug Administration (FDA) for intervention and explored how patients can control the side effect from the comfort of their homes. CURE®: Can you explain what types of cancer treatment cause oral mucositis? Villa: Oral mucositis is an iconic toxicity of cancer therapy and remains one of the most painful and disrupting side effects of radiation therapy and chemotherapy. When I talk about radiation therapy, I talk about patients with head and neck cancer. In these patients, usually 100% receiving radiation therapy develop oral mucositis. We also see mucositis in approximately 60% to 80% of patients who undergo bone marrow transplants. And finally, we see it in 20% to 40% of patients who receive conventional chemotherapy for any cancer. What are the consequences of oral mucositis? Oral mucositis is one of the most painful toxicities in patients receiving radiation therapy to the head and neck. It’s the number one cause of hospitalization in these patients. It can [...]

2019-11-03T10:21:56-07:00November, 2019|Oral Cancer News|
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Palifermin Decreases Severe Oral Mucositis of Patients Undergoing Postoperative Radiochemotherapy for Head and Neck Cancer: A Randomized, Placebo-Controlled Trial

Source: OncologyStat.com TAKE-HOME MESSAGE This randomized, placebo-controlled trial found that weekly palifermin was associated with decreased incidence and duration of severe oral mucositis in patients undergoing postoperative chemoradiotherapy for head and neck cancer. SUMMARY OncologySTAT Editorial Team Combined chemoradiotherapy (CRT) offers improved outcomes after resection of locally advanced head and neck cancer but also increases the risk of oral mucositis, a debilitating and potentially dose-limiting toxicity of locoregional treatment. Palifermin, an analogue of keratinocyte growth factor, is FDA approved to prevent and treat mucositis in patients undergoing high-dose myelotoxic therapy for hematologic malignancies. In this multicenter, randomized, placebo-controlled trial, Henke et al evaluated whether palifermin reduces severe oral mucositis in patients undergoing CRT after surgical resection of locally advanced head and neck cancer. Adult patients receiving postoperative CRT for high-risk stage II to IVB head and neck squamous cell carcinoma and with an ECOG performance status of 0 to 2 were enrolled from 38 centers in Europe, Australia, and Canada. Eligible study patients were stratified by tumor location (oral cavity/oropharynx or hypopharynx/larynx) and residual tumor (R0 [complete resection] or R1 [incomplete resection]). Study patients received a radiation dose of 60 Gy (R0 group) or 66 Gy (R1 group) plus cisplatin 100 mg/m2 on days 1 and 22, with the study drug administered 3 days prior to starting CRT and then weekly for 6 weeks. Patients who underwent radiotherapy after 6 weeks received an additional 100 mg/m2 of cisplatin and study drug. Oral saline rinses, topical anesthetics, feeding tubes, and hematopoietic [...]

2011-09-20T10:21:43-07:00September, 2011|Oral Cancer News|
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Palifermin reduces severe mucositis in head and neck cancer

Source: http://www.medscape.com/ Author: Janis C. Kelly Palifermin (Kepivance), which is currently approved for preventing mucositis associated with total-body irradiation and stem-cell transplantation in hematologic malignancies, also prevents oral mucositis in patients with head and neck cancer undergoing radiation and chemotherapy, according to 2 randomized trials published online June 13 in the Journal of Clinical Oncology. Michael Henke, MD, who led both studies, told Medscape Medical News that "this shows for the first time that radiation-induced mucositis can be ameliorated — and this in a phase 2/3 design!" Dr. Henke is from the Department of Radiation Oncology at University Clinic in Freiburg, Germany. The multicenter studies included researchers from Austria, France, Germany, Hungary, Italy, Poland, Spain, the United Kingdom, and the United States. The first study was a double-blind randomized placebo-controlled trial of 186 patients with stage II to IVB carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Treatment included radiation, 60 or 66 Gy, after complete or incomplete resection, delivered at 2 Gy per fraction and 5 fractions per week. Treatment also included cisplatin 100 mg/m2 on days 1 and 22 (and on day 43 with incomplete resection). Patients were randomized to weekly palifermin 120 μg/kg or placebo from 3 days before and throughout radiochemotherapy. The primary end point was the incidence of severe oral mucositis (World Health Organization [WHO] grades 3 to 4). Palifermin reduced oral mucositis incidence to 51% (41 of 92), compared with 67% (63 of 94) with placebo (P = .027), shortened median mucositis from [...]

2011-07-03T09:08:28-07:00July, 2011|Oral Cancer News|
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Palifermin decreases severe oral mucositis after radiotherapy

Source: www.drbicuspid.com Author: Will Boggs, MD Palifermin (Kepivance) helps reduce the rate, severity, and duration of severe oral mucositis in head and neck cancer patients receiving chemoradiotherapy, two new studies show. "Combined data from both studies consistently indicated that palifermin has activities against radiochemotherapy-induced mucositis," said Dr. Quynh-Thu Le, who led one of the studies, in email to Reuters Health. "However, the lack of improvement in some of the secondary end points suggests that the doses and schedules tested were inadequate to overcome the severe mucositis brought on by concurrent radiochemotherapy." The recombinant keratinocyte growth factor palifermin is FDA-approved to treat severe oral mucositis in patients with hematologic malignancies receiving myelotoxic therapy requiring hematopoietic stem cell support. But Dr. Le said that unlike the mucositis related to chemotherapy for bone marrow transplant, mucositis from chemoradiotherapy is more severe and persistent and "may require more drug administered at a higher frequency." Dr. Le, from Stanford University, California, and colleagues tested palifermin, 180 mcg/kg IV once weekly, in 188 patients with locally advanced head and neck cancer receiving definitive chemoradiotherapy. The incidence of severe oral mucositis (grade 3 or 4) was significantly lower with palifermin versus placebo (54% versus 69%; p = 0.041). In addition, the median duration of severe oral mucositis was shorter in the palifermin group (5 versus 26 days), according to a report published online June 13 in the Journal of Clinical Oncology. But mouth and throat soreness (MTS) scores averaged only slightly lower in the palifermin arm, and [...]

2011-06-14T10:16:17-07:00June, 2011|Oral Cancer News|
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Palifermin Decreases Severe Oral Mucositis of Patients Undergoing Postoperative Radiochemotherapy for Head and Neck Cancer: A Randomized, Placebo-Controlled Trial

Source: Journal of Clinical Oncology Purpose: Radiochemotherapy of head and neck cancer causes severe mucositis in most patients. We investigated whether palifermin reduces this debilitating sequela. Methods: We conducted a multicenter, double-blind, randomized, placebo-controlled trial in 186 patients with stages II to IVB carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Patients received 60 or 66 Gy after complete (R0) or incomplete resection (R1), respectively, at 2 Gy/fraction and five fractions per week. Cisplatin 100 mg/m2 was administered on days 1 and 22 (and on day 43 with R1). Patients were randomly assigned to receive weekly palifermin 120 μg/kg or placebo from 3 days before and continuing throughout radiochemotherapy. Trained evaluators performed oral assessments twice weekly. The primary end point was the incidence of severe oral mucositis (WHO grades 3 to 4). Overall survival and time to locoregional progression were also assessed. Analysis was by intention to treat. Results: Severe oral mucositis was seen in 47 (51%) of 92 patients administered palifermin and 63 (67%) of 94 administered placebo (P = .027). Palifermin decreased the duration (median, 4.5 v 22.0 days) and prolonged the time to develop (median, 45 v 32 days) severe mucositis. Neither patient-reported mouth and throat soreness scores nor treatment breaks differed between treatment arms. After median follow-up of 32.8 months, 23 deaths (25%) had occurred in both treatment arms, and disease had recurred in 25 (27%) and 22 (24%) of palifermin- and placebo-treated patients, respectively. Conclusion: Palifermin reduced the occurrence of severe oral mucositis in [...]

2011-06-14T09:57:52-07:00June, 2011|Oral Cancer News|
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ASCO updates guideline on chemotherapy and radiation protectants

Source: www.medscape.com Author: Nick Mulcahy In its first issuance since 2002, the American Society of Clinical Oncology (ASCO) has released an updated guideline on the use of protectants for chemotherapy and radiation therapy. The update provides new guidance on the use of palifermin, the only new protectant approved by the US Food and Drug Administration since 2002, as well as new or deleted recommendations for amifostine and dexrazoxane. The updated guideline, published online November 17 in the Journal of Clinical Oncology, also addresses the concern that protectant agents could compromise tumor response and survival. Palifermin, a recombinant keratinocyte growth factor, was approved for prophylaxis against severe mucositis associated with hematopoietic stem-cell transplantation in hematologic malignancies. It represents "an advance for the field," write the guideline authors, cochaired by Martee L Hensley, MD, from Memorial Sloan-Kettering Cancer Center, in New York City, and Lynn M. Schuchter, MD, from the University of Pennsylvania, in Philadelphia. Because of the growing body of evidence on amifostine use in the prevention of esophagitis, the ASCO panel of experts decided to add a new section on this topic in the chemoradiotherapy setting for non–small-cell lung cancer. Updates on amifostine also include guidance on its use for both chemotherapy and radiation-therapy toxicities. With regard to dexrazoxane, the panel made only 1 change from the previous guidelines: guidance on its use in patients receiving high-dose anthracycline therapy has been deleted because of insufficient data. However, the panel highlighted its previous and ongoing recommendation that this agent not be [...]

2008-11-25T22:27:09-07:00November, 2008|Oral Cancer News|
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